Chronic Non-specific Back Pain Research Articles

Complex therapy of musculoskeletal pain: the role of centrally acting muscle relaxants

Chronic pain is the main manifestation of musculoskeletal diseases (MSDs), leading to deterioration of quality of life and loss of ability to work. The importance of this problem is determined by the widespread prevalence of MSDs, osteoarthritis (OA), acute and chronic non-specific back pain (NBP), periarticular soft tissues lesions. Introduction of effective methods of treatment of musculoskeletal pain (MSP) into medical practice is one of the fundamental tasks of modern medicine.The pathogenesis of MSP includes mechanisms such as injury, inflammation, peripheral sensitization, biomechanical disorders, dysfunction of the nociceptive system and psychoemotional disorders. Painful muscle tension plays an important role in the development of MSP, especially in NBP. Given the complex pathogenesis of MSP, its treatment is based on the combined use of drugs with different mechanisms of action and nonpharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) have a central place in this context. However, they can cause serious adverse reactions (ARs), so when choosing NSAIDs, it is necessary to consider comorbid pathology and risk factors. One of the most acceptable NSAIDs with a pronounced analgesic effect and low incidence of ARs is aceclofenac, which is available in various dosage forms (tablets, sachets, topical cream for external use). This medication is characterized by proven efficacy and good tolerability.Centrally acting muscle relaxants (CM) play an important role in the treatment of MSP. They eliminate muscle spasm, enhance the effect of analgesics and reduce the need for NSAIDs. The effect of CM has been demonstrated in spasticity and NBP. However, the use of many drugs of this group can be associated with serious ARs, which limits their use.Tolperisone has the best combination of efficacy and favorable safety profile among CM. Its positive effect in the complex treatment of NBP has been confirmed in several well-organized, placebo-controlled trials. There are also studies demonstrating the efficacy of tolperisone in OA. An important advantage of this drug is virtually no sedative effect, and no negative impact on hemodynamics and on the ability to perform concentration-intensive work. Emergence of a new form of tolperisone – extended-release tablets (Mydocalm® Long 450 mg) – increases patient compliance with CM therapy and facilitates the physician's work.

Typical tactics of treatment of patients with chronic non-specific back pain and tension-type headaches

Non-specific (musculoskeletal) back pain (NBP) and tension-type headache (THA) are among the most common conditions in neurological practice that significantly impair patients' ability to work. The typical practice of treating patients with NBP and THA has not been sufficiently investigated, which formed the basis for conducting this study.Objective: to evaluate the quality of diagnosis and treatment of chronic NBP and THA in real-life neurological practice.Material and methods. The study included 120 patients with chronic NBP and combined THA of different frequency (32 men and 88 women, mean age 38.4±9.6 years) who were treated in A.Ya. Kozhevnikov Clinic of Neurologic Diseases (CND) of Sechenov University with complaints of back pain and headache and who had previously been examined and treated by neurologists and therapists in other medical institutions on an outpatient and/or inpatient basis. All patients underwent a clinical interview to establish a diagnosis and analyze previous treatment, a neurological and neuro-orthopedic examination and a psychometric examination to assess anxiety and depression symptoms.Results. Prior to contacting CND, only 10% of patients had a diagnosis of chronic NBS, only 7% had a diagnosis of THA and the remaining patients had other misdiagnoses. All patients had previously undergone additional examinations, mainly neuroimaging of the spine and brain, ultrasound examination of the neck vessels, even if there were no "red flags" – signs of danger in back pain and headache. None of the patients had previously had their emotional state assessed, while 75% of patients had symptoms of depression of varying severity and all patients suffered from anxiety of varying severity. Neuro-orthopaedic examination was performed in only 10% of patients. All patients received nonsteroidal antiinflammatory drugs for back pain, and most patients received vascular and nootropic medication for headaches. Of the non-pharmacological methods, massage and passive physiotherapy were most frequently prescribed. Only 9% of patients were recommended kinesiotherapy, and only 5% of patients performed it.Conclusion. In real-life medical practice, chronic NBP and THA are inadequately diagnosed, excessive and unjustified additional examinations are prescribed, unsatisfactory level of treatment, and patients with chronic NBP and THA are rarely prescribed kinesiotherapy.

Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case-Control Study.

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case-control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing-abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing-contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting-contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting-voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature.

Isometric Fatigue Resistance of Lumbar Extensors and Cardiovascular Strain in Lower Back Pain Patients Are Associated with Angiotensin-Converting Enzyme and Tenascin-C Gene Polymorphisms

Background: We tested whether gene polymorphisms for angiotensin-converting enzyme (ACE, rs1799752) and tenascin-C (TNC, rs2104772) are associated with variability in fatigue resistance and metabolic strain during static lumbar exercise through interactions with chronic nonspecific lower back pain and habitual physical exercise levels (PA). Methods: Forty-eight patients and matched controls performed an isometric endurance test for lumbar extensors. Metabolic strain to longissimus muscle (oxygen saturation, lactate) and cardiovascular system (muscle hemoglobin, blood pressure) and holding time were monitored. Subjects were genotyped for rs1799752 (II, ID, DD) and rs2104772 (AA, AT, TT). Associations of variance with group, genotype, and PA were analyzed under a 5% false discovery rate. Results: The holding time was lower in patients than in controls (150.9 vs. 188.6 s). This difference was associated with both genotypes, as patients with DD-rs1799752-genotype (p = 0.007) and TT-rs2104772-genotype (p = 0.041) showed lower fatigue resistance. Muscle deoxygenation during exercise varied in positive association with the rs2104772-genotype and PA (p = 0.010, η2 = 0.236). Mean arterial blood pressure (p = 0.028, η2 = 0.108) and recovery of hemoglobin concentration (p = 0.003, η2 = 0.907) demonstrated complex group x rs2104772 interactions. Conclusions: Polymorphisms rs1799752 and rs2104772 influence back pain-related variability in lumbar fatigue resistance. rs2104772 was linked to cardiovascular strain during isometric exercise and recovery via muscle perfusion.

A Comparison of Combined Pilates-Kinesio Tape and Mulligan-Kinesio Tape Exercises on Pain, Lumbar Range of Motion, Hamstring Strength, and Pelvic Rotation in Women with Non-specific Chronic Low Back Pain

Background: Low back pain is one of the most significant musculoskeletal problems, causing various functional limitations that adversely affect individuals' quality of life. Objectives: The effect of combined Pilates-Kinsey and Mulligan-Kinsey exercises in women with non-specific chronic back pain has not been investigated. Methods: In the present quasi-experimental study, thirty women with non-specific chronic back pain with a range age of 35 - 65 years old were included in the study and were randomly divided into two Pilates-Kinesiotype (n = 15) and Mulligan-Kinesiotype (n = 15) groups. Exercise interventions were conducted for 6 weeks and 3 sessions per week. Pain, lumbar range of motion, hamstring stiffness and hip rotation were measured before and after the training intervention. Also, analysis of covariance (ANCOVA) test was used to analyze the data. Results: The results showed that there is a significant difference between the effect of Pilates-Kinesiotype training and Mulligan Kinesiotype training in the variables of pain, hamstring stiffness and hip rotation (P < 0.05) and the reduction of pain and hip rotation in the Pilates-Kinesiotype training group compared to The Mulligan-Kinesiotype group was better. But the hamstring range of motion was better in the Mulligan-Kinesiotype group than in the Pilates-Kinesiotype group. In addition, the results showed that there is no significant difference between the waist range of motion of the research groups (P < 0.05). Conclusions: Due to the fact that mulligan and Pilate's exercises together with Kinesiotype have an effect on pain variables, hamstring stiffness and hip rotation, and each of mulligan and Pilate's exercises have different effectiveness. These exercises can be used in combination with Kinesiotype to help women with non-specific chronic back pain.

Comparison of 8 Weeks of Selected TRX Training and Weight Training on Improving Motor Function and Chronic Nonspecific Back Pain in Women Aged 35 to 55

Comparison of 8 Weeks of Selected TRX Training and Weight Training on Improving Motor Function and Chronic Nonspecific Back Pain in Women Aged 35 to 55

Treatment of chronic non-specific (musculoskeletal) back pain

Treatment of patients with chronic non-specific back pain (CNBP) is an important issue not only in medicine, but also in modern society as a whole, as it is associated with significant socio-economic burden.The lecture presents the most common anatomical sources of CNBP, the causes of CNBP and issues of differential diagnosis. Much attention is paid to the basic principles of therapy for CNBP: drug therapy, kinesiotherapy and psychological methods. Clinical observations are presented that demonstrate the effectiveness of a multimodal integrated approach to the treatment of CNBP based on the use of cognitive behavioral therapy, educational programs and kinesiotherapy and self-monitoring test tasks.

Clinical effect of suspension training and Mulligan technique in combination with celecoxib in the treatment of chronic non-specific lower back pain

Clinical effect of suspension training and Mulligan technique in combination with celecoxib in the treatment of chronic non-specific lower back pain

The relationship between single leg balance and proprioception of the knee joint in individuals with non-specific chronic back pain

BackgroundProprioceptive information from the hips, knees, and ankles as well as joint coordination are important for maintaining and controlling balance. Regional receptors in the muscles, joints, skin, and tendons as well as proprioception in the knee joint provide the necessary joint activity and stability. Pain may occur with a decreased sense of balance and proprioception. ObjectiveTo investigate the relationship between single-leg balance and proprioception of the knee joint in individuals with non-specific chronic low back pain. DesignFifty-two individuals with non-specific chronic low back pain, 30 females and 22 males, were included in our study, with a range of 18–50 years (mean age:25.15 ± 8.2 years). MethodPain intensity at rest and activity was assessed using Visual Analogue Scale (VAS), and disability and function were assessed using Oswestry Disability Index (ODI). Single-leg balance measurements were performed using Prokin TecnoBody kinematic balance device. A goniometer was used to evaluate the proprioception of the knee joint. ResultsThere were low-level negative correlations between VAS resting pain intensity and medium-lateral standard deviation value (p = 0.018; r = −0.327) and ellipse area measure (p = 0.039; r = −0.287) from static balance assessments. There were low-level negative correlations between VAS activity pain intensity and medium-lateral standard deviation value (p = 0.039; r = −0.288), ellipse area (p = 0.044; r = −0.281), and perimeter measure (p = 0.043; r = −0.282) from static balance assessments. No correlation was seen between ODI and clinical balance and proprioception assessments (p > 0.05). There was no correlation between clinical balance and proprioception evaluations (p > 0.05). ConclusionAs a result of the study, it was decided that there is a minimal relationship between single-leg balance and knee joint proprioception in people with nonspecific low back pain.

Interventional effect of core stability training on pain and muscle function of youth with chronic non-specific lower back pain: A randomized controlled trial

Nowadays, due to lifestyle changes, the number of young people suffering from chronic non-specific low back pain (CNLBP) is gradually increasing. The recent guidelines for the treatment of low back pain emphasize that exercise therapy is the preferred treatment method for CNLBP. This study take ordinary college male students with CNLBP as objective of the study, focused into how core stability training affected the pain and muscle function of the CNLBP of youth. Herein, 60 male subjects were randomly divided into a control group and an experimental group, and conducted a randomized control trial in the Sports Rehabilitation Laboratory of Guangxi Normal University from September to October 2023. The control group received traditional waist strength training, while the experimental group received core stability training. VAS scores, pain symptoms scores and clinical efficacy grades were evaluated. Waist muscles fitness was evaluated, including back muscle strength, the prone upper body up's static holding time, 1-min modified sit-ups' pcs, the supine abdominal curling's static holding time and the supine leg raising's static holding time. Waist movement function was also evaluated using oswestry disability index (ODI) questionnaire. Surface electromyographic (EMG) signals were collected from rectus abdominis, erector spinae and multifidus. The independent sample t-test was used to compare groups, and the paired sample t-test was used for the data comparison before and post-exercise within the group. The results of the study found that CNLBP was improved in both the experimental and control groups in the post-exercise. Compared to pre-exercise, there are significant decrease in the VAS scores (95%CI: 2.51 to 6.51, p = 0.000), pain symptoms scores (95%CI: 2.95 to 3.55, p = 0.000), waist movement function's evaluation scores for ODI (95%CI: 2.23 to 4.31, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.29 to 4.39, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.18 to 4.45, p = 0.000) of experimental group in the post-exercise. Compared to pre-exercise, there are significant improvement in the back muscle strength (95%CI: 12.85 to 19.49, p = 0.000), the prone upper body up's static holding time (95%CI: 9.67 to 19.17, p = 0.000), the 1-min modified sit-ups' pcs (95%CI: 8.56 to 18.12, p = 0.000), the supine abdominal curling's static holding time (95%CI: 6.73 to 19.14, p = 0.000), and the supine leg raising's static holding time (95%CI: 8.21 to 18.35, p = 0.000) of experimental group in the post-exercise. In the post-exercise,there are significant lower in the VAS scores (95%CI: 1.41 to 4.98, p = 0.000), pain symptoms scores (95%CI: 1.14 to 1.79, p = 0.011), waist movement function's evaluation scores for ODI (95%CI: 1.13 to 2.25, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.36 to 4.47, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.24 to 4.23, p = 0.017) of experimental group than those of control group. In the post-exercise, there are significant higher in the recovery rate (p = 0.000), the prone upper body up's static holding time (95%CI: 4.16 to 8.32, p = 0.008), and the supine abdominal curling's static holding time (95%CI: 3.89 to 7.44, p = 0.000) of experimental group than those of control group. Therefore, it can be concluded that core stability training is significantly effective in treating CNLBP in youth, enhancing lower back muscle function. This therapeutic effect is primarily attributed to the improvement in muscle function.

Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain.

Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70-80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland-Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.

The Impact of Baseline Pain Intensity on the Effectiveness of Whole-Body Electromyostimulation (WB-EMS) for Nonspecific Chronic Back Pain.

Recent clinical studies confirmedthat whole-body electromyostimulation (WB-EMS) training is a safe and time-efficient therapeutic method for patients with nonspecific chronic back pain (NSCBP). However, significant variations in initial pain intensity among subjects in these studies have been observed. This study aims to determine if patients with differing initial pain intensities experience varying degrees of benefit from WB-EMS and to assess the overall correlation between initial pain levels and pain reduction. Pain intensity datasets from two studies were combined. The pooled data included 121 NSCBP patients (38 males and 83 females) with an average age of 55.1 years (±11.8 years). Data was categorized by baseline pain intensity on the numeric rating scale (NRS) into seven groups: 0 to 2, >2 to 3, >3 to 4, >4 to 5, >5 to 6, >6 to 7, and >7. Both absolute and relative changes were analyzed. Additionally, a Spearman rho correlation test was performed on the entire dataset to evaluate the relationship between initial pain level and pain reduction. Significant improvements were noted across all NRS11 categories, with strong effect sizes (p) in all classes above 2, ranging from 0.56 to 0.90. The >7 category exhibited the highest rate of clinically significant changes (80%) and an average improvement of 3.72 points. The overall group from >1 to 10 showed an average improvement of 1.33 points, with 37% of the participants experiencing clinically significant improvements. The Spearman rho correlation test revealed a moderate positive relationship between initial pain level and pain reduction (r_s = 0.531, p < 0.001), indicating that, generally, higher initial pain levels are associated with greater pain reduction. The findings support the hypothesis that NSCBP patients with higher baseline NRS values benefit more substantially from WB-EMS. Those with NRS values above 7 show the greatest improvement and highest rate of clinical significance. The overall positive correlation between initial pain intensity and pain reduction further underscores the efficacy of WB-EMS in managing NSCBP across different pain intensities.

Alflutop Russian longitudinal multicenter observational study: use in patients with chronic back pain (message 3)

The use of slow-acting disease-modifying symptomatic drugs, such as bioactive concentrate from small marine fish (BCSMF, Alflutop), is considered a potential element of complex therapy for chronic non-specific back pain (CNBP).Objective: to evaluate the efficacy of the BCSMF in patients with CNBP in real-life clinical practice.Material and methods. An open observational study included 10,047 patients with CNBP (age – 58.3±14.9 years, 58.4% women) with moderate or severe pain – 60 [50; 70] mm on the visual analogue scale (VAS). All patients received a course of BCSMF medication: 1 ml intramuscular (IM) daily No. 20 or 2 ml IM every other day No. 10. 68.8 % of patients also took non-steroidal anti-inflammatory drugs. Treatment outcomes were assessed 10 days after completion of BCSMF therapy (30 days after initiation of treatment).Results and discussion. As a treatment result, the pain intensity according to the VAS decreased from 60 [50; 70] to 20 [10; 30] mm (p&lt;0.0001), the patients’ overall health assessment according to the VAS increased from 50 [30; 60] to 80 [60; 90] mm (p&gt;&lt;0.0001) and the quality of life assessment (EQ-5D) – from 0.52 [0.06; 0.66] to 0.8 [0.71; 1] points (p&gt;&lt; 0.0001). A good response to treatment (pain reduction &gt;50%) was observed in 73% of patients. On average, an improvement was observed on the 8th [5; 10] day of BCSMF therapy. There were no serious adverse effects associated with the use of the drug. Older age, overweight, initially more severe pain, and the presence of comorbid conditions were slightly more frequently associated with a less pronounced response to therapy.Conclusion. The use of BCSMF rapidly and effectively reduces the severity of pain and other symptoms associated with CNBP.

Virtual reality training and pain neuroscience plus motor control on pain, disability, health, and quality of life of women with non-specific chronic back pain

Background: Non-specific chronic low back pain is defined as a complex disorder involving structural, biomechanical, cognitive, psychological, social, and lifestyle factors. This randomized clinical trial study compared the effects of 8-week Virtual Reality Training (VRT) and pain neuroscience plus motor control training (PNE/MCT) on pain, disability, health, and quality of life of women with non-specific chronic back pain. Methodology: This research is a single-center parallel RCT. Thirty-six participants participated in this study. They were divided into two groups: VRT (G1) and PNE/MCT (G2), both with 18 women. The training was performed for eight weeks for 45 minutes – 60 minutes. The VRT was applied by Oculus Quest 2. Visual Analogue Scale (VAS), disability (Oswestry Disability Index), general health (GHQ-28), and quality of life (QOL- WHO) were assessed before and after eight training weeks using a within-between group analysis (ANOVA 2×2). Results: Before training, no difference was observed between the groups (p &gt; 0.05). After the intervention, both groups improved VAS, disability, GHQ, and QOL (all p &lt; 0.001). In the comparison between the groups, the G1 had a better performance according to the p-value and effect size in anxiety (p = 0.001, ES= 0.71), depression symptoms (p = 0.03, ES: 0.25), physical health (p = 0.03, ES: -0.24), mental health (p = 0.001, ES: 0.66), and total QOL (p = 0.048, ES: 0.21) than G2. Conclusion: Despite the effectiveness of both interventions, VRT improved the general health and quality of life in women with NSCLBP more than PNE/MCT.

Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale.

Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.

The Effect of Cognitive Functional Therapy on Psychological Variables in Women With Non-specific Chronic Back Pain: A Randomized Control Trial

Purpose: Chronic non-specific low back pain (CNSLBP) is a common health issue caused by a mix of biological, psychological, and social factors. Cognitive functional therapy (CFT) is a comprehensive way to treat CNSLBP that focuses on changing negative thoughts and unhelpful habits through relaxation techniques. Since the evidence on the efficacy of CFT is still limited, it is essential to conduct clinical trials aimed at the effectiveness of CFT in the treatment of CNSLBP. This study aims to examine the effect of cognitive functional therapy on psychological variables in women with CNSLBP. Methods: Thirty women with CNSLBP were recruited for the clinical trial. They were randomly divided into two experimental and control groups (15 patients in each group). Our experimental group will have 18 individualized CFT sessions, each lasting an hour, over two months. The control group received no intervention. Pain intensity, disability, and kinesiophobia were assessed via the visual analog scale, Oswestry, and Tampa scale, respectively. Two-way repeated measures analysis of variance (ANOVA) was used to compare results between groups. Results: Two-way repeated measures ANOVA results showed that the experimental group compared to the control group in reducing pain (P=0.000, ηp2=0.787), disability (P=0.005, ηp2=0.457) and Kinesiophobia (P=0.000, ηp2=0.561) had a significant difference. Conclusion: CFT reduced pain, disability, and kinesiophobia in patients with CNSLBP. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among patients with CNSLBP is recommended.

Gabapentinoids: a therapeutic review.

The Australian Therapeutic Goods Administration's approved indications for prescription of gabapentinoids are refractory focal epilepsy and neuropathic pain. Use of gabapentinoids outside of the approved indications is common, but evidence for this is limited, especially for chronic nonspecific back pain and nonradicular leg pain. Some effects of gabapentinoids encourage their nonmedical use (e.g. euphoria, sedation, disinhibition). Widespread nonmedical use has increased the incidence of accidental and deliberate poisonings. Dependence may develop with chronic use of gabapentinoids and abrupt cessation may induce withdrawal symptoms. If the indication for continued use is unclear, gradual dose tapering as a means of deprescribing is recommended. Clinicians should consider the indication, patient characteristics and harm-benefit profile when prescribing gabapentinoids. Some people, such as those with kidney disease, have an increased risk of harm when using these drugs.

Hydrocortisone Differentially Affects Reinstatement of Pain-related Responses in Patients With Chronic Back Pain and Healthy Volunteers

Despite the crucial role of effective and sustained extinction of conditioned pain-related fear in cognitive-behavioral treatment approaches for chronic pain, experimental research on extinction memory retrieval in chronic pain remains scarce. In healthy populations, extinction efficacy of fear memory is affected by stress. Therefore, we investigated the effects of oral hydrocortisone administration on the reinstatement of pain-related associations in 57 patients with non-specific chronic back pain (CBP) and 59 healthy control (HC) participants in a differential pain-related conditioning paradigm within a placebo-controlled, randomized, and double-blind design. Participants’ skin conductance responses indicate hydrocortisone-induced reinstatement effects in HCs but no observable reinstatement in HCs receiving placebo treatment. Interestingly, these effects were reversed in patients with CBP, that is, reinstatement responses were only observed in the placebo and not in the hydrocortisone group. Our findings corroborate previous evidence of stress-induced effects on extinction efficacy and reinstatement of fear memory in HCs, extending them into the pain context, and call for more research to clarify the role of stress in fear extinction and return of fear phenomena possibly contributing to treatment failure in chronic pain treatment. PerspectiveOpposing effects in HCs and patients with non-specific CBP may be associated with changes in the patients’ stress systems. These findings could be of relevance to optimizing psychological, extinction-based treatment approaches.

Does an alternative breast support garment provide symptomatic relief for larger breasted women with chronic non-specific back pain?

Nonsurgical guidelines recommend implementing a correctly fitted bra when managing back pain among larger breasted women. Achieving this is challenging with current bra solutions, sizing principles, and fitting approaches. Persistent wearing of an ill-fitting bra can cause negative health implications, including non-specific back pain. This study investigated immediate and short-term biomechanical and pain responses to changing breast support garment among larger breasted women with non-specific back pain. Participants (n = 24) performed a standing task, drop jumps, and seated typing tasks while bra and spinal kinematic data were recorded. Five breast support conditions were assessed: participants' usual bra (control), a professionally fitted bra in the immediate term (standard) and after 4 weeks wear (standard28), and a bra with an alternative design, measurement, and fitting approach in both the immediate term (alternative) and after 4 weeks wear (alternative28). A bra fit assessment and clinical pain/disability questionnaires were included. All participants failed the bra fit assessment in the control bra, compared with 87.5% (n = 21) in the standard and 4.2% (n = 1) in the alternative bras. The standard28 and alternative28 bras provided symptomatic relief, with the alternative28 bra improving a greater number of outcome measures. Reduced nipple-sternal-notch distance was observed only in the alternative28 bra condition. Symptomatic relief may be associated with the resting position of the breast tissue on the anterior chest wall. The alternative bra may provide potential clinical benefit if implemented as part of a nonsurgical or conservative pain management strategy. Alternative breast support garments should be considered to provide solutions to the problems associated with traditional bras.

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study.

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting. A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large. A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.